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 The fallacy of private health care efficiency

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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 2:18 am

cactus flower wrote:
Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.

You are assuming that the developments would go ahead without the tax incentives, there is no reason to believe that would be the case and if they didn‘t go ahead of course there wouldn‘t be any tax collected anyway. In the circumstances I can‘t see that this notional tax loss could put this down to a cost.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 2:28 am

cactus flower wrote:
Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.

Is building capacity in the public system free?
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 3:15 am

tonys wrote:

Our starting point in the health debate has to be, that the status quo cannot continue, change must come. The vested interests & the ideologically driven will resist with everything they have, that was and is to be expected and so far in that regard, they’ve not disappointed.

Time and experience both here & elsewhere has shown that a 100% state monopoly on the provision of public services does not work and will never bring about customer lead high quality services provided at a sustainable cost. What you get at best is these services being run by people whose main concern is their own welfare with end user welfare coming some way down the list of the organisations priorities.
When you introduce private enterprise into the provision of services you immediately get the benefits of two elements missing from the public only model, fresh new thinking & something realistic to benchmark against, everyone involved, both public & private has to up their game.

If you take Ryanair & Airlingus as an example, (not that I would hold Ryanair up as a model employer) there can be no doubt but for the competition Ryanair introduced Airlingus would now either be gone out of business like so many other European airlines or we would still be paying 4/500 Euro for a round trip to London.


Health obviously is not the airline business, but for any real efficiency or change to come about, in any field, competition is a prerequisite, in the long term, change cannot & will not come without it.

One of the aspects of the French health system not often discussed is the fact that up to 50% of treatments are provided in private hospital facilities, another, is that everyone has to pay 20% of any medical bill, either through private insurance or by stumping up the cash.

A similar system could be introduced here with private insurance companies (at an agreed fixed margin, net of costs) providing relatively low cost community rated policies to everyone in employment and with the state paying for the policy for anyone on social welfare. The costs would probably be in the region of 150.00 Euro pa for a single and 4/500 pa for a family. Obviously the insurance option is still there for anyone who wants to provide cover for more than the basics, for private rooms etc. (This should not be tax deductible imo). The income stream generated is very useful for the management of the hospitals concerned & the better they are at what they do, whether they are public or private, the more income they generate.

There are many ways to improve the provision of services for everyone, to decide exactly what the mix of private & public will be, but in my opinion none will work long term unless the vested interests can be brought to accept & work with the necessary change in the provision of those services. If any other road is chosen, we will simply be throwing good money after bad.

Good post tonys.

Of the two paragraphs I highlighted above, the second one I fully agree with. Though I think it is a poor analogy, to compare a health service with an airline.

Regarding the first paragraph, I will have to disagree fully on this.

The motorway network in Ireland is one example. It's class..except for the privately run bits (aka toll bridges)

The M50 would be close on superb if it wasn't for that pricks 650 Million stake on a Liffey Bridge.

Paris: Best public transport system in Europe if you ask me.

New York: Best public transport system in Europe if you ask me.

Spot the error ! Point is tonys, public built is better built.

Or maybe the point is that we should not be comparing the health system to any other system....Like maybe health is different ??
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 9:54 am

seinfeld wrote:
cactus flower wrote:
Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.

Is building capacity in the public system free?

The public own the building in the public system.
In the Harney system the public pay for the building, but they don't own it.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:25 pm

EvotingMachine0197 wrote:
The motorway network in Ireland is one example. It's class..except for the privately run bits (aka toll bridges)

The M50 would be close on superb if it wasn't for that pricks 650 Million stake on a Liffey Bridge.

Paris: Best public transport system in Europe if you ask me.

New York: Best public transport system in Europe if you ask me.

Spot the error ! Point is tonys, public built is better built.

Or maybe the point is that we should not be comparing the health system to any other system....Like maybe health is different ??

In fairness I thought I made it clear that I wasn’t comparing an airline to the health service, personally I wouldn’t let O’Leary run boarding kennels, much less the health service.
I only used the airline to show the effect of competition.

I don’t think it’s necessary for me to show that state run is, from a customer service point of view, badly run, all of our experience shows us that.
You very quickly end up with a service run on the basis of buying industrial peace at all costs, the unions push continually for more and as the costs are not controlled in the way they would be in the private sector, they are pushing at an open door. For example in the public service promotion is not on the basis of service needs or merit, but on length of service or qualifications attained (usually on public time & at public expense), the result is that we end up paying the majority of staff at senior rates for doing a junior job, classic too many chiefs and not enough Indians.
In the private sector you can be there as long as you like or be as qualified as you like, but your pay is for the job you do, not the job you could do if there wasn’t someone else already doing it.

I believe in getting any job done in the best & most efficient way possible, I’m not interested in whether on any given occasion that suits a left or right perspective and I don’t believe that the prime concern of the public services should be the career paths of public servants.


Last edited by tonys on Tue May 13, 2008 2:53 pm; edited 1 time in total
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:26 pm

cactus flower wrote:
seinfeld wrote:
cactus flower wrote:
Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.

Is building capacity in the public system free?

The public own the building in the public system.
In the Harney system the public pay for the building, but they don't own it.

In the public system the public may own the building, but the building would be empty.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 1:33 pm

cactus flower wrote:
seinfeld wrote:
cactus flower wrote:
Sorry Tony, but that doesn't answer my questions. Also I don't accept that letting someone off taxes otherwise due is 'no cost'.

Is building capacity in the public system free?

The public own the building in the public system.

That isn't what I asked.

You've pointed out that foregone tax revenue is a cost.

I've asked are there any costs associated with building capacity in the public system.

From a cost point of view, it doesn't matter who owns the infrastructure.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 4:46 pm

To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it. M50 toll bridge is a good example of co-location. It is co-located next to a road that it didn't pay for. It would be worth nothing without the publicly funded M50 road running up to it. I suppose we have paid for the bridge several times over at this point and will never own it.

Under Harney's system, will the public and private hospitals be completely separate tracks? Or will one be a road leading up to another?
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 5:20 pm

cactus flower wrote:
To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

Who cares who owns it?

We don't invest in healthcare as sort of speculative property development deal.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 7:13 pm

seinfeld wrote:
cactus flower wrote:
To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

Who cares who owns it?

We don't invest in healthcare as sort of speculative property development deal.

That will be bad news for Mary. That is entirely what she is depending on in terms of 'co-location' investment. Shocked Do you think Barringtons and the Beacon were built for the good of someone's health? and I thought you were a fine upstanding capitalist Seinfeld.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 8:35 pm

cactus flower wrote:
seinfeld wrote:
cactus flower wrote:
To reiterate: in both public and private systems the public/users pay for the building. In the private system, the public pay for it but don't own it. In the public system they do own it.

Who cares who owns it?

We don't invest in healthcare as sort of speculative property development deal.

That will be bad news for Mary. That is entirely what she is depending on in terms of 'co-location' investment. Shocked Do you think Barringtons and the Beacon were built for the good of someone's health? and I thought you were a fine upstanding capitalist Seinfeld.

Of course, private hospitals are built to make money.

So what?

What difference does it make if a public patient is treated in a private hospital paid for by the HSE or a public hospital paid for by the HSE?

You seem more concerned with who owns the assets than patient outcomes.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 9:20 pm

If the public patient has paid for the asset, and then has to pay again to use it, or indeed may be excluded from using it if not in funds, it would be a matter of some interest to the patient.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 9:28 pm

cactus flower wrote:
If the public patient has paid for the asset, and then has to pay again to use it, or indeed may be excluded from using it if not in funds, it would be a matter of some interest to the patient.

What?

The public patient pays taxes.

Those taxes are used to either pay the private sector to provide the public patient with healthcare or to build public healthcare facilities which the public patient can then use.

Whats the big deal?

The focus should be on the quality and cost of the care provided, not who owns the assets.
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PostSubject: Re: The fallacy of private health care efficiency   Tue May 13, 2008 9:55 pm

A couple of questions:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

How will competition operate with co-located hospitals? Will it be between the private and public hospital on the same land or in some other way? The assumption is that competition gives incentives for provision of best services (Eircom has no competitor).

Is competition seen as a factor at all indeed?

Are our consultants over-paid? How big an issue is that if they are? Would the co-located model break this somehow?

We might need more regulators - this would not necessarily be a factor with public hospitals.

Is tonys' vision of a system where everyone pays €150 a year for an adequate health service really realisable? I'm assuming a ballpark of under €500 a year which is still far less than VHI as far as I know yet the Germans pay twice that and more per year for their health insurance.

Does Harney or whoever need to attack the insurance companies a bit more so all sorts of health-associated insurance isn't so much an expensive overhead as I strongly suspect it is at present?

I'll have more questions later.
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PostSubject: Re: The fallacy of private health care efficiency   Wed May 14, 2008 11:36 am

Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

The comparison with Eircom doesn't stand.

Eircom owns the entire residential leased line infrastructure in the country, whereas private health care operators will own only a fraction of our health care infratructure.

Eircom has a total monopoly on the residential leased line market, so it doesn't need to invest in it for competitiveness. All private hospitals have to compete with other private hospitals, and the entire public system.

Underinvestment in the private sector will only arise through declining demand, which can only result from increased capacity in the public systemor a more health population, both of which are welcome alternatives in my book.

Again, private healthcare is being painted as some sort of evil based on a perception that it is only available to people with money.

The reality is that private health care facilities will be available to everyone through the NTPF. The State is simply taking the view that it should provide for public patients by shopping around for the best quality care rather than investing tax payers money in public systems that clearly don't work.
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PostSubject: Re: The fallacy of private health care efficiency   Thu May 15, 2008 10:55 am

The 'efficiency' of private health care is a complete lie. The only 'efficiency' referred is the efficiency with which it makes profits for the health insurers and other companies:

Here is the reality in the US - check out the information at the blue links for the complete picture:



"Here we see why employer-based health insurance just does not work.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.
With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.
“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.
Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills.
“That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”
The cost is even more when one is self-employed or when an employer doesn’t offer health insurance and one must pay for it out of pocket. Imagine, the same $4,ooo+ as the families yearly deductible on top of $1000+ per month premiums (that’s a yearly expenditure of $16,000, which is taxable but you never see). You better have a damn good job if you have to buy your own health insurance.
Even more heinous, I get the distinct feeling that this article is preparing us to see more articles on employer increases on health care.

Companies and policy makers have yet to focus on what the faltering economy means for employees’ medical care, said Helen Darling, president of the National Business Group on Health, a Washington association of about 200 large employers.
“It’s a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession,” she said. “Americans have been giving their pay raise to the health care system.”
Let me be the first to put a little salt in your wounds, profits. Insurance companies profiting from you, or maybe I should just say this is the Free Market at it’s ugliest.

In 2006, the nation’s six biggest private health insurers collectively earned almost $11 billion in profits.
As these companies rake in their profits from your misfortunes and fears, the uninsured and under-insured are dying sooner.
The reasons for socialized medicine keep mounting."
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PostSubject: Re: The fallacy of private health care efficiency   Thu May 15, 2008 11:32 am

from the above
Quote :
But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.
Shocked mother of god are those costs normal? $700 a month for health insurance? With stories like that you'd be sick with worry as to what would happen you if you did get sick...

it must be a rare case though ... Time to post a question on Boards.USA or JoeDuffy.America and find out how much and how often this type of story happens in the states - maybe we could try to learn from it. Prevention is better than cure in case it gets to that stage here.
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PostSubject: Re: The fallacy of private health care efficiency   Thu May 15, 2008 1:11 pm

Auditor #9 wrote:
from the above
Quote :
But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.
Shocked mother of god are those costs normal? $700 a month for health insurance? With stories like that you'd be sick with worry as to what would happen you if you did get sick...

it must be a rare case though ... Time to post a question on Boards.USA or JoeDuffy.America and find out how much and how often this type of story happens in the states - maybe we could try to learn from it. Prevention is better than cure in case it gets to that stage here.

You can depende on it that it will A9. This is a style of health care being foisted on the Irish nation from the same people who say that 'a little inequality is a good thing'.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 18, 2008 3:00 pm

seinfeld wrote:
The focus should be on the quality and cost of the care provided, not who owns the assets.

All (not just a majority) of peer-reviewed studies, --published in the most respected journals and going back decades,-- have shown for-profit privatised health care to be less efficient (to cost more), to deliver lower quality care with higher mortality rates (mainly due to perverse profit based incentives) and to be much more bureacratic than publicly provided non-profit health care.

The idealogy here is with those who are working 24/7 to privatise the Irish health system. Most specifically that's Harney, and the corporate-loaded HSE she created.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 18, 2008 4:26 pm

Pax wrote:
seinfeld wrote:
The focus should be on the quality and cost of the care provided, not who owns the assets.

All (not just a majority) of peer-reviewed studies, --published in the most respected journals and going back decades,-- have shown for-profit privatised health care to be less efficient (to cost more), to deliver lower quality care with higher mortality rates (mainly due to perverse profit based incentives) and to be much more bureacratic than publicly provided non-profit health care.

The idealogy here is with those who are working 24/7 to privatise the Irish health system. Most specifically that's Harney, and the corporate-loaded HSE she created.

Whilst on an intuitive level I agree it seems probable Pax, do you have any links to any of these studies?
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 18, 2008 8:54 pm

cactus flower wrote:
Pax wrote:
seinfeld wrote:
The focus should be on the quality and cost of the care provided, not who owns the assets.

All (not just a majority) of peer-reviewed studies, --published in the most respected journals and going back decades,-- have shown for-profit privatised health care to be less efficient (to cost more), to deliver lower quality care with higher mortality rates (mainly due to perverse profit based incentives) and to be much more bureacratic than publicly provided non-profit health care.

The idealogy here is with those who are working 24/7 to privatise the Irish health system. Most specifically that's Harney, and the corporate-loaded HSE she created.

Whilst on an intuitive level I agree it seems probable Pax, do you have any links to any of these studies?

Well there's unfortunately not much Irish studies, (however it's clear the costs are still higher here too and if you have any then I'd appreciate it) but there's plenty of research elsewhere particularly in the US, but also in the UK, Canada and Australia, all of which confirm the above
The most interesting would be meta-analyses of studies going back decades.


When Money is the Mission — The High Costs of Investor-Owned Care
http://content.nejm.org/cgi/content/short/341/6/444
Quote :
"Market medicine's dogma, that the profit motive optimizes care and minimizes costs, seems impervious to evidence that contradicts it. For decades, studies have shown that for-profit hospitals are 3 to 11 percent more expensive than not-for-profit hospitals2,3,4,5,6,7; no peer-reviewed study has found that for-profit hospitals are less expensive.... "

The high costs of for-profit care
http://www.cmaj.ca/cgi/content/full/170/12/1814

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
http://www.cmaj.ca/cgi/content/full/170/12/1817

Costs of Care and Administration at For-Profit and Other Hospitals in the United States
http://content.nejm.org/cgi/content/short/336/11/769
Quote :

“Conclusions Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals. Overall costs of care were also higher at for-profit hospitals.”

Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation
http://content.nejm.org/cgi/content/short/341/22/1653

Quote :
Conclusions: In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.

The Association between For-Profit Hospital Ownership and Increased Medicare Spending
http://content.nejm.org/cgi/content/short/341/6/420
Quote :

Conclusions: Both the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.

Going for the gold: the redistributive agenda behind market-based health care reform
http://www.ncbi.nlm.nih.gov/pubmed/9159711

Can markets give us the health system we want?
http://www.ncbi.nlm.nih.gov/pubmed/9159710

The Corporate Transformation of Medicine and Its Impact on Costs and Access to Care
http://www.jabfm.org/cgi/content/full/16/5/443

Figure 1. Private insurer’s high overhead. Investor-owned plans are worst. Source: Schramm, Blue Cross conversion, Abell Foundation, and CMS.

Quote :
Dialysis Centers

Eighty-five percent of dialysis centers in the US are for-profit, and they compare poorly with their not-for-profit counterparts—death rates are 30% higher with 26% less use of transplants in 1 study reported in 1999.81 A more recent systematic review and meta-analysis estimated that there are 2500 excessive premature deaths each year in US for-profit dialysis centers.82

Emphasis on bottom-line profits leads to cutbacks of staff and the use of shorter dialysis periods (average of 10 hours per week in the United States compared with 12 in Germany and 14 in Japan).12, pp137–8 Frensenius Medical Care North America (a German firm) is the largest provider of kidney dialysis products in the world, with more than 800 dialysis facilities in the US. After pleading guilty to charges of conspiracy and fraud, it paid $486 million in fines and settlements to the government in 2000.83

[...]

It would be one thing if investor-owned, corporate health care brought increased efficiency and value to the market, but just the opposite is the case. Instead, for example, the huge for-profit health insurance industry takes one quarter of the health care dollar while separating the relatively healthy from the sick and fragmenting the risk pool.90 For-profit plans and facilities are consistently found to have lower quality of care than their not-for-profit counterparts, whether HMOs32 hospitals,15–18 dialysis centers,81,82 or nursing homes.86 Table 1 *summarizes some of the evidence documenting increased costs and lower quality of care in investor-owned facilities.

*
http://www.jabfm.org/cgi/content/full/16/5/443/T1
Quote :
Table 1. Investor-Owned Care: Comparative Examples versus Not-For-Profit Care

Hospitals: Costs 3% to 13% higher, with higher overhead, fewer nurses, and death rates 6% to 13% higher.11,17,88

HMOs: Higher overhead (25% to 33% for some of the largest HMOs), worse scores on 14 of 14 quality indicators reported to National Committee for Quality Assurance32,33

Dialysis centers: Death rates 30% higher, with 26% less use of transplants81,82

Nursing homes: More citations for poor quality of care (30% committed violations which caused death or life-threatening harm to patients)85


Mental health centers: Medicare expelled 80 programs after investigations found that 91% of claims were fraudulent89


For-Profit-Hospitals Costlier and Less Efficient
http://www.pnhp.org/news/1997/october/forprofit_hospitals.php
Quote :

"Bureaucracy costs jumped sharply when non-profit and public hospitals were purchased by for-profits. If all U.S. hospitals became for-profit, hospital paperwork would rise by $14.8 billion annually," noted Woolhandler. She continued: "It's a myth that for-profit hospitals are efficient. They save money by laying off nurses, then hire consultants and bureaucrats to figure out how to avoid unprofitable patients and maximize revenues. For-profits increase costs, decrease care, and generate windfall profits, like the $359.5 million pocketed by Rick Scott of Columbia/HCA in 1996. They're fat and mean." [New England Journal of Medicine, March 1997]


More broadly speaking none of this is surprising as health care is very different to other areas of an economy,

The high costs of for-profit care
http://www.cmaj.ca/cgi/content/full/170/12/1814

Quote :
Several prerequisites for the competitive free market described in textbooks are absent in health care.19,20

First, it is absurd to think that frail elderly and seriously ill patients, who consume most care, can act as informed consumers (i.e., comparison-shop, reduce demand when suppliers raise prices or accurately appraise quality). Even less vulnerable patients can have difficulty gauging whether a hospital's luxurious appurtenances bespeak good care.

Second, the "product" of health care is notoriously difficult to evaluate, even for sophisticated buyers like government. Physicians and hospitals create the data used to monitor them; self-interest puts the accuracy of such data into question. By labelling minor chest discomfort "angina" rather than "chest pain," a US hospital can garner both higher Medicare payments and a factitiously improved track record for angina treatment. It is easier and more profitable to exploit such loopholes than to improve efficiency or quality...


And as regards those perverse incentives. You have the dialysis studies above but sudies have highlighted an increased tendencies to engage in unnecessary cardiac surgery when (less profitable) medication will suffice. In other words, you get your chest opened to improve corporate profits.

http://bmj.bmjjournals.com/cgi/reprint_abr/326/7398/1055.pdf

Quote :
Dozens of patients allege unnecessary heart surgery
25, 91

A lawsuit brought on behalf of 82 patients who were allegedly subjected to unnecessary cardiac surgery at Redding Medical Center, Redding, northern California, has been filed in a Californian county superior court.

Nine of the 82 patients later died, and some of the deaths have been attributed to the unnecessary surgery, the lawsuit says. It further contends that a deliberate push for high profits prompted the hospital and doctors to perform inordinate numbers of highly profitable heart procedures, whether they were necessary or not.

Last October the Federal Bureau of Investigation raided the offices at the Redding Medical Center of cardiovascular surgeon Dr Chae Hyun Moon and director of cardiovascular surgery Dr Fidel Realyvasquez Jr, but no charges have yet been filed (BMJ 2002;325:1130). With Dr Moon performing 10-12 cardiac catheterisations a day, about 2400 cardiac catheterisations were done at the Redding Medical Center last year, earning $94m (£59m; €82m) last year for its owners Tenet Healthcare Corporation. Dr Moon, 55, who stopped his practice in February, because he could not get malpractice insurance, has said that he was saving lives. Fred Charatan Florida
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 18, 2008 9:01 pm

Thanks for that Pax I will give it proper attention tomorrow when the site is (hopefully) back to normal.
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PostSubject: Re: The fallacy of private health care efficiency   Sun May 18, 2008 10:04 pm

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?


Last edited by seinfeld on Mon May 19, 2008 2:40 am; edited 1 time in total
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PostSubject: Re: The fallacy of private health care efficiency   Mon May 19, 2008 12:34 am

seinfeld wrote:
Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

The comparison with Eircom doesn't stand.

Eircom owns the entire residential leased line infrastructure in the country, whereas private health care operators will own only a fraction of our health care infratructure.

Eircom has a total monopoly on the residential leased line market, so it doesn't need to invest in it for competitiveness. All private hospitals have to compete with other private hospitals, and the entire public system.

Underinvestment in the private sector will only arise through declining demand, which can only result from increased capacity in the public systemor a more health population, both of which are welcome alternatives in my book.

Again, private healthcare is being painted as some sort of evil based on a perception that it is only available to people with money.

The reality is that private health care facilities will be available to everyone through the NTPF. The State is simply taking the view that it should provide for public patients by shopping around for the best quality care rather than investing tax payers money in public systems that clearly don't work.

People have to be able to get near a consultant in order to have anything to do with the NTPF
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PostSubject: Re: The fallacy of private health care efficiency   Mon May 19, 2008 2:39 am

cactus flower wrote:
seinfeld wrote:
Auditor #9 wrote:

The private hospitals will be out of control of the state so I'm wondering if it could eventually end up like the Eircom network - an infrastructure in need of an upgrade but the private sector won't have the interest in doing that and the state won't have the control.

The comparison with Eircom doesn't stand.

Eircom owns the entire residential leased line infrastructure in the country, whereas private health care operators will own only a fraction of our health care infratructure.

Eircom has a total monopoly on the residential leased line market, so it doesn't need to invest in it for competitiveness. All private hospitals have to compete with other private hospitals, and the entire public system.

Underinvestment in the private sector will only arise through declining demand, which can only result from increased capacity in the public systemor a more health population, both of which are welcome alternatives in my book.

Again, private healthcare is being painted as some sort of evil based on a perception that it is only available to people with money.

The reality is that private health care facilities will be available to everyone through the NTPF. The State is simply taking the view that it should provide for public patients by shopping around for the best quality care rather than investing tax payers money in public systems that clearly don't work.

People have to be able to get near a consultant in order to have anything to do with the NTPF

That's true, but we've been talking about in-patient issues for the last 4 pages.

Out-patient care is a whole different kettle of fish and really has nothing to do with co-location.

Hopefully, the new consultants contract will provide for the employment of more consultants, and especially consultants on public-only contracts.
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